To reduce safety risks, we promote a culture of safety and reliability, and emphasize personal accountability. We also coach clinical teams on the importance of safety vigilance and reporting, and train them to consistently:
- Use error prevention tools that reinforce adherence to safety practices, consider safety in all they do and speak up when they see unsafe behaviors.
- Capture safety events and near-misses so we can identify trends and accelerate improvements.
- Keep conditions sanitary and sterile to prevent health care-associated infections.
- Conduct morning safety briefings to address all safety concerns.
- Alert system safety leaders when issues arise to mitigate additional risks and share safe management practices.
- Communicate with the care team to confirm they receive critical information or results on time.
- Dispense the correct medications at the right dose at the right time.
- Confirm the appropriate surgical site and correctly identify patients before any procedure.
To identify where adverse events are occurring and their root causes, we examine data and analytics. We then make necessary refinements or introduce new methods that are proven to be more effective at preventing harm.
Reliable Care Blueprinting™ is a care design process involving both physicians and staff. They discuss challenges, collaborate on best practices and then create a standard approach to delivering evidenced-based care for various procedures. We apply the process broadly – from how we take a patient’s vitals to treating sepsis to processing lab specimens. To drive ongoing improvements, we review industry benchmarks, share lessons learned and set aggressive performance goals.
We actively listen, observe and communicate with patients and their families to provide better care experiences and health outcomes. Through our intake and discharge process and regular rounding, our care teams engage patients to drive alignment and understanding of their treatment plans. This also helps us identify individuals at risk for poor self-management and readmission based on their health history.
According to the American Association of Colleges of Nursing, “strengthening nursing leadership at the point at which care is delivered” reduces readmissions, improves patient satisfaction and safety, drives compliance with core measures and saves money. Texas Health’s team of clinical nurse leaders (CNLs) manages the clinical care given to groups of 12 to 16 patients.
With master’s degrees in nursing, CNLs work with unit managers, physicians, care transition team members and bedside nurses at all wholly owned hospitals to improve care delivery. They do this by providing continuity of care, rounding with physicians at the patient’s bedside and analyzing clinical data to provide optimum acute care coordination. Additionally, they mentor, bring evidence-based practices to the bedside, assist patients with health-decision planning and collaborate with the care transition team to provide patient support upon discharge. This helps to align the entire care team on care plans, a safe discharge and follow-up requirements.
We design care transition plans based on patients’ unique needs, their support systems and network of providers. Prior to discharge, we share patients’ health histories and care plans with other providers to coordinate follow-up care and monitoring. Effectively managing patients’ transitions from hospital to home helps us improve health outcomes, and reduce their length of stay and likelihood of readmission.
Our patient navigators help people newly diagnosed with a severe or chronic health issue, or who face a long recovery from an injury or illness, from getting overwhelmed. They help patients find and receive health services, coordinate appointments, send medical records, arrange for translators, assist with paperwork and more. After discharge, they also follow-up with patients to confirm they are receiving the care and attention they need.
The team of infection preventionists, medical staff physicians, and staff help protect patients, employees and other caregivers from health care-associated infections. From handwashing, requiring masks, gloves or gowns, and ensuring sanitary equipment and tools, they put infection-prevention processes in place and monitor enforcement.
Texas Health has deployed more than 35 care modules to improve safety and quality in the last two years. These have helped reduce patients’ average length of stay from 4.76 days in 2017 to 4.3 days.
The Joint Commission surveyed our system in 2018 to assess quality and safety measures as part of its three-year accreditation process and reaccredited 100 percent of our hospitals, including joint ventures. Findings showed significant improvements since the 2015 evaluation, and we had fewer issues than national benchmarks. Surveyors also praised our infection control processes as being some of the best they had seen.
Also during the year, Texas Health:
- Trained more than 1,000 leaders and reliability coaches in a peer-to-peer approach that provides real-time affirmation and redirection when using error prevention tools.
- Experienced a 20 percent increase in the reporting of near-misses, which allows us to investigate and eliminate potential risks before they occur.
- Improved screening for communicable diseases upon patient admission to reduce possible transmission to staff, visitors and other patients.
- Created a systemwide infection reduction plan and associated strategies. This helped us reduce Clostridium difficile, a bacterial infection, by more than 23 percent.
- Deployed central line and urinary catheter maintenance checklists to verify these devices are properly maintained and removed as soon as possible. By year-end, we had reduced catheter-associated urinary tract infections by 21 percent and central-line-associated bloodstream infections by 28 percent.
- Facilitated the rollout of a patient safety event classification system that allows us to cross-check how safety events are classified and track the effectiveness of efforts to improve reliability in patient safety performance.
|All-cause readmission rate (omissions: errors threshold)||1.06||0.95
|Overall mortality observed/expected||1.0||0.76
|Central-line-associated bloodstream infections (CLABSIs)||0.80||0.54
|Catheter-associated urinary tract infections (CAUTIs)||1.00||1.03
|Sepsis mortality observed/expected||0.85||0.86
|Excess days observed/expected||1.447||1.467
Medicare.gov rates the quality of patient care at Medicare-certified hospitals on its Hospital Compare site. You can review the performance of applicable Texas Health entities here. More data can be found in our Quality & Safety Report.
In 2019, Texas Health will focus on reducing surgical site infections after colon procedures and hysterectomies. Texas Health retained an infectious disease physician to champion this initiative and will collaborate with surgeons and anesthesiologists to achieve improved performance.